Hacker News Reader

Comment by tunesmith | Hacker News Reader

Well, the 2% Medicare tax is, from their perspective, something that should never have passed in the first place. So repealing it is going back to a previous form of status quo.

Beyond that, I think it's the basic philosophy that government should not be involved in funding health care for citizens (I think those high-risk pools are basically being set up to fail/abandon). I don't really understand it, because I don't see how the normal arguments of self-reliance and accountability translate to sickness, which is by definition out of our control no matter how self-reliant and accountable we are.

View on HN

Here's a different perspective: if the government is involved in paying for your healthcare, that gives voters a say in how you live your life. Taking too many risks? Like wine or soft drinks a bit too much? Maybe you enjoy rock climbing, or horse riding, or skiing, or some other dangerous activity? Well, maybe I don't want to pay for your risks, and I get to call you a drunk, fat and lazy, or foolhardy and reckless, needing more regulation and laws to keep you in your place - and your health costs low. We'll ban tasty food, nice drinks, and any activities that are more than a standard deviation or two out of the normal risk profile. We'll have a nice gentle bland life mapped out for you with low health costs.

IMO the biggest elephant in the room is rationing. We can't give infinite healthcare to everybody for all their lives, particularly in very old age. We need to make hard trade-offs. In a free market system, the rationing is done by affordability and price levels: we choose who's more worthy of living longer by how much capital they've accumulated. In a more centralized system, we might choose to pay for interventions based on how much extra "life" they give, and ration by selecting a threshold for how much we pay for extra life year - this is how the UK NHS works, where life year is a QALY, quality-adjusted life year. But anything that doesn't address this elephant in the room, and appeals to emotions about the poor, sick, elderly, dying because they can't afford the treatment they need without considering who exactly we're going to leave to die and why, because we can't all be each other's caregivers for life, is intellectually bankrupt.

This law literally tells you how to live your life, especially if you're a woman: No kids, no reporting sexual assault, ...

As per your claim on the NHS I'm not sure what are you trying to imply. Do you think the NHS or other similar systems choose to let people die based on economic reasons? Because that'll be a surprise. Disclosure: I live in the UK and grew up in Spain, where last night my grandmother passed at the age of 99 after A LOT of healthcare was poured into her (despite the fact she never had "a job"), of course paid by taxes.

The NHS does have a guidelines published by NICE. Doctors would follow those when deciding care. It's not about your contribution to the economy, but about the patients quality of life and future life expectancy. Being 99 means she could have had another decade if an acute illness was corrected.

Things get difficult when patients have longer term chronic illnesses. If she had kidney failure and heart desease the doctors who probably discuss a different care plan.

It's a lot more likely that your insurance company will come down on your rock climbing, horse riding, vodka drinking, etc. than that government will do so. Rationing will happen by bankruptcy and/or death.

The "supply" of medical care does seem quite tight to me, but increasing spending doesn't necessarily lead to rationing, it depends on whether there is existing underutilized supply and how difficult it is to increase the supply.

Like for existing drugs that are profitable but expensive to produce. Our industrial capacity is such that producing those drugs doesn't really impose any medical opportunity cost.

One thing I appreciated about Obamacare is how its structure flowed pretty logically from the value, or moral axiom, that people should not be able to go bankrupt from health care costs alone.

That's also the kind of value that people can disagree on, though. For as much as we might believe that it's unfair for someone to do all the right things and then still end up with the wrong illness and go bankrupt, for others that is the natural order of things.

Although it's worth pointing out that it was still possible (pre-ACA) to go bankrupt from health care costs even if you had done well at amassing capital.

Altogether I think that's why so many people see this as deeply distorted and unfair, the sort of thing that government should smooth out.

> I don't see how the normal arguments of self-reliance and accountability translate to sickness, which is by definition out of our control no matter how self-reliant and accountable we are.

The "Just World Hypothesis". Many supporters, either overtly or subconsciously, believe that people get sick because they "deserve" to in some moral way. The universe is punishing for their sins, so why should taxpayers pay them off?

You can see an example of this worldview in this thread in fact, with the comment: "People who drive their cars recklessly and who speed pay higher auto insurance premiums. People who choose poor lifestyle behaviors (smoking, drinking daily Cokes, not exercising, drug use) were subsidized by those who 'drove safely.'"

> the basic philosophy that government should not be involved in funding health care for citizens

Why not just privatize the police, the fire department, the military, the national highway system, everything? Why is helping sick people so different from helping pay people to put out fires for homes that don't belong to you?

If these people demanding taxpayer-funded healthcare were responsible enough to get real jobs before getting cancer, then we wouldn't be having this discussion.

Is this satire? Are you serious? Do you know people get all kinds of illnesses at all ages and do you know that hospital bills are so high that even gainfully employed people in "real jobs" would have trouble paying for them with all their life savings? How much do you think a stay in the hospital is? How much do you think insurance will cost you if you have a medical condition? What if your insurance drops you or you lose it somehow and now you can't afford new insurance because you got sick?

I know sarcasm doesn't always translate, but dude... come on.

https://en.wikipedia.org/wiki/Poe%27s_law

Reply on news.ycombinator.com